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New Hampshire rates for HCPCS A5114

Leg strap; foam or fabric, replacement only, per set

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.62 / $6.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $6.03 / $14.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $7.59 / $8.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $7.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.33 / $9.33 / $16.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.88 / $4.17 / $6.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.25 / $9.33
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $11.48